Author: Marian Chandler

Congratulations to Dr Libby Haskell (Starship Children’s Hospital) and Dr Sharon O’Brien (Perth Children’s Hospital) for receiving the following awards:

DR LIBBY HASKELL
Best Presentation: College of Emergency Nurses NZ Conference (CENNZ), held in Christchurch 19 & 20 October 2023. 
Presentation title: “Can targeted interventions change clinicians beliefs in the treatment of infants with bronchiolitis?”

This abstract was submitted in 2020 with authors from the KT bronchiolitis study and PREDICT network. The conference was delayed repeatedly until this year (Libby presented the main KT bronchiolitis results at the 2019 CENNZ conference).
Libby tweaked the content a little so it was a full wrap up of the entire PREDICT KT bronchiolitis study, with the last piece of the puzzle being the results of the staff surveys “Can interventions change clinicians beliefs?”.

Libby at the conference dinner in the “Cardboard Cathedral” in Christchurch.

DR SHARON O’BRIEN
Best Nursing Presentation: 2023 Child Health Research Symposium, WA
Presentation title: “Evidence based management of infants with bronchiolitis – Why is it so hard?.”

The results of two publications – Prevalence of high flow nasal cannula therapy use for management of infants with bronchiolitis in Australia and New Zealand (JPCH 2022) and Factors influencing health professionals’ use of high-flow nasal cannula therapy for infants with bronchiolitis – A qualitative study (Frontiers in Paeds 2023), were presented.

Sharon with her nursing prize.

 

2023 has been a great year as we emerged from the pandemic and moved ahead with our research with renewed enthusiasm!   

It was the fourth year of our current 2020-2024 NHMRC Centre for Research Excellence (CRE) collaboration.  With the end in sight for this grant we submitted a proposal for another CRE grant and were delighted to be successful on the first pass.  The new CRE grant will commence in 2024 – 2028 and will support a new program of emergency research in the years to come.

Please join us to reflect on these and other outstanding achievements:

• PREDICT now has 221 members – in the past year we welcomed 34 new members.
• 58 hospitals across Australia and New Zealand have been actively involved in PREDICT research!
• Fifty-three clinical research staff from 23 sites across Australia, attended training for the CHOICE UTI, Mental Health Observational, FEBCON, SPASMS and Asthma prospective studies.  This event was held at the Murdoch Children’s Research Institute in Melbourne on 24th and 25th July 2023.
• Four members of the PREDICT executive (Simon Craig, Stuart Dalziel, Elliot Long and Franz Babl) were invited to the EMCON2023 conference for the Society of Emergency Medicine in India in Hyderabad, where they ran a one-day workshop aiming to support the beginning of a multicentre PEM research network in India. This was well-received, and we plan to continue the collaboration with another visit in the first half of 2024.
• PREDICT has continued working actively with consumers in our research. Our mental health consumer group recruited for “The Kids are not Okay” program of research has been actively involved in the development and fine tuning of the Mental Health Delphi project, the PEACHY-O and M studies, and the Prospective Observational study.

  We have commenced a Head injury/Concussion Co-design project that involves parents, youths and clinicians working in partnership to develop discharge materials for children with mild head injury/concussion. Lots of valuable insight has been gained to date and draft materials recruited. Final testing of the co-designed resources for ED will take place in early 2024.

  Other consumer groups have been working with research teams to develop the FEBCon study, and to inform a number of grant applications (on topics including steroids in pre-school wheeze, recognition of clinical deterioration, asthma, and pain/distress associated with nasogastric tube insertion). We are currently asking consumers about priorities for future PEM emergency research.

• This year we have had 3 successful grants to the value of $2.8M.
• We continue our work on translating best practice in bronchiolitis care. We have published 3 studies this year relating to translation of the Bronchiolitis Guideline recommendations. Work is well underway to update the Australasian Bronchiolitis Guideline from 2016.  Teams are currently reviewing new evidence and the finalised guideline will be ready in 2024.
• The PEAChY-O study, the RCT to determine the most effective oral sedation for children presenting with acute severe behavioural disturbance, completed enrolment 12 months early (n=348)! Kids THRIVE – the RCT on high flow for intubation has completed enrolment (n=961).  SENTINEL (observational study to collect data characterising sepsis) study is now drawing to a close (n=>7,000). An amazing effort from all teams involved.
• We continue to undertake work collaboratively with the international PERN Pediatric Emergency Research Network) group on the PERN Asthma study (a global multicenter, retrospective Study). With PERC we continue to recruit in the BIPED study (Dexamethasone and Adrenaline for bronchiolitis) and our other international studies include the PROMPT Bolus Study (with PECARN (US) and PERC (Canada)).
• Currently, a significant number of large multicentre studies are ongoing in Australia and New Zealand, while others also involve international sites. These include SONIC (Study Of Neck Injury imaging in Children) also involving Singapore; CHOICE UTI (an RCT comparing a single IV dose of antibiotics to 3 days of IV antibiotics in children with complicated UTI);  PEAChY-M (RCT comparing droperidol and olanzapine for children with behavioural disturbance requiring IM sedation; PROMPT Bolus (an RCT comparing balanced vs normal saline fluid bolus for resuscitation in children with suspected septic shock); SENTINEL (a prospective observational study to collect data characterising sepsis) and the Australian and New Zealand ED Airway Registry (ANZEDAR).
• New studies that commenced recruiting this year were: the SPASMS project (on assessment of abdominal pain) which has commenced recruiting in WA with other sites to join soon; The Asthma prospective study “CASPAR” and the MH Prospective study are both about to commence. FEBCon will commence early next year along with PASSPORT and SENTINEL International.
• Our two committed teams undertaking Cochrane reviews continue to progress work on:
  “Triage tools for detecting cervical spine injury in paediatric trauma patients”
  “Parenteral medication for the management of acute severe behavioural disturbance (ASBD) in the emergency department.”
• Data analysis is complete and papers are underway for the Western Australia Bronchiolitis Knowledge Translation Adaptability study; PERN pneumonia; BellPIC and the Mental Health Delphi study.
• The PREDICT Executive reviewed and endorsed 6 new projects, many of which are now in various stages of development.
• We are mentoring 7 PhD scholars and congratulate 2 PhD students- Sharon O’Brien (Perth) and Sonia Singh (UC Davis/Melbourne) – who completed their PhD studies at the start of the year.
• Eighteen papers were published in various journals including: The Lancet, Journal of the American Medical Association (JAMA); ACTA Paediatrica; Neurology; BMC Health Services Research; BMJ Open Respiratory Research; Journal of Paediatrics and Child Health; JMIR (Journal of Medical Internet Research) Human Factors; Emergency Medicine Journal; Arch Phys Med Rehabilitation; Medical Journal Australia and others!
• The annual PREDICT members meeting was held in November in Melbourne with a live and online audience of 61 members.  It was great to be able to see people again!

  Thank you to all members and collaborators for your contributions and support.

The annual PREDICT members meeting was held on Wednesday November 15th 2023 with 34 people attending in person in Melbourne at the Murdoch Children’s Research Institute and another 23-30 online at various stages of the meeting.  

The meeting included a range of informative presentations from the project leads covering projects now analysed, those in development and those that are currently active.  It was also a great opportunity to hear ideas for new research projects and to thrash these out with the membership. 

We also enjoyed hearing from guest speakers. Prof Tom Snelling, clinical scientist, Director of Health and Clinical Analytics in the School of Public Health at the University of Sydney, and an infectious diseases physician in the Sydney Children’s Hospitals Network, presented on how AI can assist us in the management of serious infections in children. Prof Kate Lee, Group Leader and Senior Principal Research Fellow with the Clinical Epidemiology and Biostatistics Unit (CEBU) at the MCRI, also presented on adaptive platform and stepped wedge trial designs. 

The highlight of the afternoon however, was a research panel consisting of RAs from Royal Darwin Hospital, Starship Childrens, Perth Childrens and Women’s & Children’s Hospital, Adelaide discussing strategies to enhance recruitment and staff engagement in research.

We thank everyone who was involved (presenters, chairs, moderators and audience) and hope you enjoyed it.   

We look forward to another exciting year of collaborative research and another meeting in 2024! 

Four members of the PREDICT executive (Simon Craig, Stuart Dalziel, Elliot Long and Franz Babl) were invited to the EMCON2023 conference for the Society of Emergency Medicine in India in Hyderabad. PREDICT ran a one-day workshop aiming to support the beginning of multicentre research in India. This was well-received, and we plan to continue the collaboration with another visit in the first half of 2024.

Congratulations to Amit Kochar from the Women’s and Children’s Hospital, Adelaide for being awarded the honorary title of Clinical Associate Professor (University of Adelaide).  The award was based on research and educational achievements, service, and leadership in his field.

 

Study of Neck Injury Imaging in Children (SONIC): Improving the Diagnosis of Spinal Cord, Bone and Ligament Injuries

Many children sustain head and neck trauma during their lifetime. Significant neck injuries – to spinal cord, neck bones and connecting ligaments – can be identified by performing neck imaging with x-rays, or, if needed, computed tomography or magnetic resonance imaging. Yet, it is unclear which children should receive neck imaging in the emergency department (ED), especially in the context of increasing concerns about radiation-induced cancer in children and the discomfort and delays of immobilisation prior to imaging.

This study aims to:

• investigate the accuracy of existing neck injury clinical decision rules (CDRs) to detect neck injuries in children (external validation) of adult focussed CDRs and the newly developed paediatric PECARN CDR;
• derive and validate a new CDR for neck imaging in children (the SONIC CDR);
• assess the cost implications of different CDRs in children;
• investigate the epidemiology of cervical spine injuries in ANZ.

Study design:

Multicentre, prospective observational study.

Timeframe:

2020 – 2025

Sites:  See link to SONIC project page.

Sample:

PREDICT ~30,000 (depending on prevalence of injuries), children aged <16 yrs with sustained or suspected blunt trauma with at least one of the following: Initiation of spinal precautions pre ED arrival, neck pain and/or considered at risk of CSI by any assessing clinician.

News:

Recruitment has commenced at all sites with over 7000 patients enrolled to date.

We have recruited approximately 100 patients to date with eligible cervical spine injuries (2/3 of the required number).  These eligible patients for accuracy analysis are currently being reviewed by the study spinal surgeons.

Sites are doing an amazing job at recruitment and keeping our missed eligible patient rate at a minimum.

We project that study recruitment will need to continue throughout 2024 and potentially to early 2025 at some sites to ensure we reach the required number of positive injuries. 

 

Cochrane Review – Triage tools for detecting cervical spine injury in paediatric trauma patients

Co-ordinating PI:

Emma Tavender

Study Co-ordinator: N/A

Project aim/s:

To expand the scope and update the Cochrane review ‘ Triage tools for detecting cervical spine injury in paediatric trauma patients (updated search from 2017 to 3 June 2021) to determine the diagnostic accuracy of clinical decision rules (CDRs) or sets of clinical criteria used to evaluate for cervical spine injury (CSI) following blunt trauma in a paediatric population.

Study design:

Cochrane Diagnostic Accuracy Review.

Study types:

Diagnostic studies with cross-sectional or cohort designs (retrospective or prospective) and randomised controlled trials. We only included results from full reports. We excluded case-control studies and reports that evaluated predictor finding models because of the bias they might introduce. We preferred studies that evaluated the accuracy of CDRs in direct comparisons to each other, however, we did not exclude studies with indirect comparisons as we expected the number of studies with direct comparisons to be limited.

Index test:

Any CDR or set of clinical criteria that compared the diagnostic accuracy of the test for the target condition with the reference standard.

Reference test:

Computed tomography (CT), plain radiography (X-ray) or magnetic resonance imaging (MRI). We also included studies where the cervical spine was clinically cleared in the emergency department in low risk patients at the treating clinician’s discretion. We preferred to include studies where patients who did not receive imaging underwent either a medical record review or an additional follow up some time after discharge to ensure no CSIs were missed or other systems were used to ensure initially missed CSI were diagnosed. The imaging or clinical follow up should be undertaken within 72 hours of presentation to the ED.

Target condition:

Clinically-important cervical spine injury (CSI), defined as any fracture, dislocation, ligamentous injury or spinal cord injury (either detectable by diagnostic imaging or spinal cord injury without radiographic association) involving the cervical region and attaching ligamentous structures.

Current status:

Completed, accepted and currently being copy-edited.

 

 

 

Our “Getting to Know You” segment ensures PREDICT members are aware of new members, their interests and areas of expertise and where they are located.

This month we introduce Katherine Cantos from Monash Children’s Hospital.

“I work at Monash Children’s Hospital in Emergency, the Canopy ward and now with the paediatric ED research team! I’m very interested in research as I’d love to be a part of learning about and making improvements to the care we provide in hospital so that we can improve oucomes for unwell children all over the world. Every little bit counts and I’ve very much enjoyed getting on board with the research team to work with other nurses and doctors in our Emergency Department in a variety of different and interesting projects.”

Welcome to PREDICT Katherine!

 

 

 

 

 

Congratulations to the following PREDICT authors:

Curran J, Wozney L, Tavender E, Wilson C, Ritchie KC, Wong H, Gallant A, Somerville M, Archambault PM, Cassidy C, Jabbour M, Mackay R, Plint AC “Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians”. JMIR Hum Factors 2023;10:e46379 doi: 10.2196/46379  PMID: 37819696.

Parr M, Wilson CL, Jones B, Crawford NW, Ferguson S, Ramesh S, Eapen N, Craig S, Hearps S, Babl FE. Emergency department presentations for chest complaints after mRNA COVID‐19 vaccinations in children and adolescents. Emergency Medicine Australasia. 2023-10-23. DOI: 10.1111/1742-6723.14327.